Trump releases healthcare plan that would have major implications for the industry

President Donald Trump’s newly released healthcare plan would promote transparency and consumerism and usher in significant changes to coverage, with some stakeholders saying more information is necessary to make a valid assessment of the pros and cons.

Touted as a push to address societal affordability issues, the plan requires Congress to fill in the details.

“I’m calling on Congress to pass this framework into law without delay,” Trump said in a Jan. 15 statement.

The process of converting the proposals into a formal bill figures to be complex, however. And to become law, the plan would need the support of at least seven Democrats in the Senate unless provisions get rolled into a reconciliation bill similar to the 2025 legislation known as the One Big Beautiful Bill Act (such a tactic allows bills to pass via a simple majority instead of requiring 60 votes).

Democrats have long been opposed to any healthcare bill that would affect the viability of the Affordable Care Act (ACA).

Affordable Care Act questions loom

The introduction of Trump’s plan coincided with waning confidence about the prospects of reaching a bipartisan deal to renew the ACA enhanced subsidies that expired Jan. 1.

Within the last week, senators in a bipartisan working group expressed optimism that a two-year extension would get done. In subsequent days, however, the tone changed.

“We are in a little bit of a pothole,” Sen. Bernie Moreno (R-Ohio), who has been leading the negotiations, told reporters. He said he planned to “take a pause” until hearing from Democratic leaders “that they are willing to contemplate a deal that extends these enhanced premium tax credits [the subsidies] with the reforms we’ve outlined.”

The sides said several areas of disagreement remained, including coverage of abortion services by ACA plans. In addition, a few days before releasing his new framework, Trump said he might veto an extension of the subsidies due to the cost.

Without an extension, many enrollees will face significant price hikes to maintain their ACA coverage for 2026. KFF estimates that out-of-pocket premiums would increase by 114% on average, and the Congressional Budget Office has projected that the uninsured rate would rise by 2.2 million in the first year.

CMS recently released enrollment numbers through early January, roughly 12 days before the Jan. 15 end of Healthcare.gov open enrollment. Nearly 22.8 million people were enrolled, a decrease of 800,000 from the same point in 2025. A greater drop-off could be seen in the upcoming final tally if people decided not to enroll in the remaining days or if they decline to effectuate their coverage by making their first premium payment.

If the Senate agrees on an extension, the enrollment window would be lengthened to March 1, legislators have said.

What Trump wants to do on healthcare

Goals of Trump’s plan include lowering prescription drug prices and healthcare premiums and ramping up transparency.

For pharmaceuticals, the plan includes most-favored-nation policies that tie prices to the least expensive rates paid among peer countries. The framework also includes provisions allowing a wider array of prescription drugs to be sold over the counter, as well as reforms to pharmacy benefit manager (PBM) business practices.

The plan also builds on the health savings account (HSA) concept as touted in recent months by congressional Republicans. Sen. Bill Cassidy (R-La.) proposed a system in which consumers can receive HSA funding to help cover their deductibles and copays. The idea is to steer consumers toward low-premium ACA bronze or catastrophic plans and then give them money to at least partially defray the high deductibles that accompany those plans.

Language in Trump’s framework implies consumers could also use the funding to buy their own insurance. That approach would open up more options, potentially including plans outside the ACA marketplaces, but also could destabilize the risk pool for ACA plans if younger and healthier enrollees depart the marketplaces.

Similar to the Senate plan that would extend the enhanced subsidies, Trump’s plan funds cost-sharing reduction (CSR) payments for low-income enrollees. That step would be projected to reduce silver-plan baseline premiums, which insurers increased as a mechanism for financing CSRs after Congress pulled the funding in 2017. In turn, however, the ACA subsidies for buying those plans would decrease, meaning out-of-pocket premium payments would rise for some enrollees.

Emphasizing transparency requirements for healthcare stakeholders

Trump’s plan would obligate providers participating in Medicare and Medicaid to prominently post their prices and fees “in their place of business” and to “answer to their patients up front on the prices they will be charged.” It’s unclear what form such a posting would take, given the volume of information seen in hospital price transparency files.

Transparency mandates for insurers would pertain to claim-denial rates and prior authorization wait times, with that information required to be available to consumers online. Company websites also would need to include plain-English summaries of the share of revenue spent on medical claims as opposed to profit and overhead.

The ACA in 2011 implemented requirements regarding thresholds for insurers’ medical loss ratios (MLRs) and the availability of MLR data, but the new proposals are intended to make the information more public-facing.

Potential benefits and drawbacks

Among healthcare organizations that commented on Trump’s proposal, the American College of Physicians (ACP) said there are encouraging aspects such as the focus on lowering the cost of prescription drugs and the effort to increase healthcare industry transparency.

“It is important to note, though, that funding for health savings accounts (HSA) is not a substitute for affordable comprehensive insurance coverage provided by Affordable Care Act (ACA)-compliant plans that guarantee coverage for recommended preventive services and ensure coverage for patients when they are sick,” ACP wrote. “Increasing funding for HSAs should supplement, not supplant, the enhanced premium tax credits for ACA marketplace plans.”

The Committee for a Responsible Federal Budget, which advocates for deficit reduction, said a key question is what Trump means when he says “extra taxpayer-funded subsidy payments” would be sent directly to consumers.

“If this refers to some or all the current-law ‘base’ ACA subsidies, the provision could very modestly reduce costs through more consumer-driven care,” the organization wrote in an analysis. “On the other hand, if the proposal is to use funding that might otherwise go to ‘enhanced ACA subsidies’ — which expired at the end of 2025 — doing so would cost the federal government up to $350 billion over 10 years.”

Cynthia Cox, senior vice president with KFF and director of the organization’s ACA policy research, wrote that missing details include who will be eligible for the funding that would replace ACA subsidies, whether the funding can pay for premiums in addition to deductibles and copays, and whether the financial support could cover off-marketplace insurance that “discriminates against people with preexisting conditions, potentially leading to instability in the ACA Marketplace.”